Differences In Postoperative Outcomes Research Articles

Can Ileostomy Reversal Be Safely Performed by Surgical Residents?

Background and Objectives: The growing number of colorectal cancer patients has highlighted the importance of surgical education in colorectal surgery. Despite the negative impact of the COVID-19 pandemic on surgical training, recent changes in the Polish surgical training program have increased the number of intestinal procedures required to be completed by residents. This study aims to assess the safety of ileostomy reversal procedures performed by surgical residents. Materials and Methods: A multicenter prospective cohort study, the LILEO study, was conducted from October 2022 until December 2023 across 20 Polish surgical departments. The study included 199 patients who underwent ileostomy reversal and were divided into two groups: 139 patients operated by specialist surgeons and 60 patients operated by surgical residents. The primary outcomes measured were postoperative complications, length of hospital stay (LOS), and 30-day reoperation rate. Secondary outcomes included the severity of perioperative complications assessed using the Clavien-Dindo classification and a focused analysis of loop ileostomy reversal outcomes. Results: The median LOS was significantly shorter in the resident group (5.5 days vs. 6 days, p < 0.05). Although the overall complication rate was lower in the resident group (21.7% vs. 33.1% in the specialist surgeon group), this difference was not statistically significant (p = 0.105). The 30-day reoperation rate was 3.3% in the resident group and 8.6% in the specialist surgeon group (p = 0.179). In terms of severity, minor complications (Clavien-Dindo grades 1 and 2) were more common in the specialist group (p < 0.05). The analysis of loop ileostomy reversals revealed no significant differences in postoperative outcomes between the two groups. Conclusions: Ileostomy reversal procedures performed by surgical residents under supervision are safe and feasible, with outcomes comparable to those performed only by specialist surgeons. These findings support ileostomy reversal as a valuable procedure for developing surgical residents' skills and do not negatively affect postoperative outcomes.

Postoperative outcomes among Northern versus Southern Ontario patients undergoing common intermediate- to high-risk elective surgeries: a population-based cohort study.

Northern Ontario residents experience multiple health disparities compared with those in Southern Ontario. It is unknown whether this leads to differences in surgical outcomes. We sought to compare postoperative outcomes of patients from Northern and Southern Ontario. We conducted a retrospective population-based cohort study using linked administrative health care data to identify all adult patients undergoing selected elective intermediate- to high-risk noncardiac surgeries in Ontario, Canada between 2009 and 2022. The primary outcome was 30-day mortality following surgery. The secondary outcomes were number of days alive at home, hospital length of stay, total health care system costs, discharge disposition, and readmissions. We used regression models to estimate the adjusted association between the exposure and outcomes. This study identified 562,115 patients, including 41,191 (7.3%) from Northern Ontario. We did not find strong evidence that mortality rates were higher for Northern vs Southern Ontario residents (adjusted odds ratio, 1.04; 95% confidence interval [CI], 0.85 to 1.27). Health system costs were lower for Northern Ontario residents at 30days [adjusted ratio of mean (RoM), 0.92; 95% CI, 0.89 to 0.96] and at 365days (adjusted RoM, 0.93; 95% CI, 0.90 to 0.96). Hospital length of stay was longer for Northern Ontario residents (adjusted RoM, 1.06; 95% CI, 1.01 to 1.11). The number of days alive at home and rate of readmission were not statistically different between the two groups. Northern Ontario residency was not associated with increased odds of mortality after intermediate- to high-risk elective noncardiac surgery. Overall, we found no clinically meaningful differences in postoperative outcomes between patients from Northern and Southern Ontario.

Comparison of The Postoperative Outcomes of Surgical Lateral Internal Sphincterotomy and Botulinum Toxin Injection in Patients Presenting With Chronic Anal Fissure At CMH, Rawalpindi

Objective: To compare the postoperative outcomes in Lateral Internal Sphincterotomy Group and in Botulinum toxin injection Group in patients managed for chronic anal fissure. Study Design: Quasi-experimental study. Place and Duration of Study: Department of Surgery, Combined Military Hospital, Rawalpindi Pakistan, from Aug 2021 to Feb 2022. Methodology: All patients of either gender, aged 30 to 70 years, who had presented to CMH, were included in this study. Block randomization was done to allocate half of them to Lateral Internal Sphincterotomy and half to Botulinum toxin injection. Patients in both Groups were followed for four weeks to assess and compare various short and long term post-surgical outcomes. Results: There were 82 patients in total with 41 in each treatment arm. In the Lateral Internal Sphincterotomy Group, 35 85(37%) of the patients reported postoperative pain relief at 24 hours, 39(95.12%) patients healed, only 2(4.88%) patients had a recurrence. In the Botulinum toxin Group, 29(70.73%) reported postoperative pain relief at 24 hours, 35(85.37%) patients healed, whereas 6(4.63%) had a recurrence. There was no statistical difference in any parameter between either Group. Conclusion: Both methods did not show any statistically significant difference in post-operative outcomes thus other parameters like patient’s choice, cost and expertise may be considered in treatment of chronic anal fissure.

Retrospective Assessment of Post-Transurethral Resection of the Prostate Complications in Benign Prostatic Hyperplasia Patients: Impact of Acute Urinary Retention.

Background Benign prostatic hyperplasia (BPH) is the most common urological condition affecting older men, leading to lower urinary tract symptoms (LUTS) and complications such as acute urinary retention (AUR), which can significantly impact quality of life. This study aims at comparing the postoperative outcomes and complication rates of monopolar transurethral resection of the prostate (TURP) in BPH patients with and without AUR. By examining the differences in postoperative outcomes, the study seeks to highlight the impact of AUR on complications such as UTIs, prolonged catheterization, and extended hospital stays, and assess the potential clinical implications for improving treatment strategies in these patients. Methodology An observational retrospective study was conducted at a tertiary care hospital in central India, over a period of two years. The study included 150 men aged 45 to 70 years with LUTS due to BPH, and participants were equally divided between two groups: Group A (AUR positive) and Group B (AUR negative). Wide-ranging assessments were performed on all patients, including history, physical examination, digital rectal examination, ultrasound, and post-void residual (PVR) urine assessment. Postoperative outcomes and complications were determined, and statistical analyses were conducted using Student's t-test with a level of significance of p < 0.05. Results The findings of the study indicated that patients in Group A, who experienced AUR, had significantly higher postoperative complications compared to Group B, who did not have AUR. Specifically, the mean complication rate was 60% in Group A compared to 30% in Group B. Common complications included urinary tract infections and prolonged hospital stays. In terms of urodynamic parameters, Group A exhibited a significantly lower maximum flow rate (Qmax) at 7.5 mL/s compared to 9.8 mL/s in Group B (p < 0.01). The average PVRvolume was also notably higher in Group A at 150.4 mL, compared to 90.2 mL in Group B (p < 0.01). These differences highlight the impact of AUR on surgical outcomes. Conclusion The findings of this study highlight the increased risks of complications associated with AUR in patients undergoing monopolar TURP. These results underscore the need for careful patient selection and management strategies to optimize outcomes. Future research should focus on expanding the sample size and incorporating multicenter data to enhance the generalizability of the results. Additionally, further investigation into long-term outcomes and the effectiveness of different management protocols for patients with AUR will be essential for improving the quality of care in the management of BPH.

Moderate hypothermia circulatory arrest as a brain-protective strategy for type A aortic dissection.

Brain-protective strategies for acute type A aortic dissection (TAAD) remain controversial. Moderate hypothermia circulatory arrest (MHCA) without cerebral perfusion is not commonly used. However, we aimed to assess its safety and efficacy in 358 patients who underwent hemiarch replacement with MHCA for acute type A aortic dissection at our institution from August 2012 to August 2022. Clinical outcomes were compared according to circulatory arrest time [≤15 min (S group, n = 52) vs ≥16 min (L group, n = 306)]. The primary outcome was postoperative stroke. The S group had more older patients (72.5 vs 68.8 years; P = 0.04), a greater incidence of carotid artery malperfusion (21% vs 11%; P = 0.043) and a lower body mass index (21.7 vs 23.6 kg/m2; P < 0.01) and hemodynamic instability (3.8% vs 16%; P = 0.02) than the L group. The incidence of postoperative stroke (7.7% vs 12%; P = 0.33) and the rate of 30-day mortality (5.8% vs 6.5%; P = 0.83) did not significantly differ between groups. After adjusting for all potential confounding factors pre- and intraoperatively, there was no significant difference in postoperative outcomes between groups. MHCA alone for TAAD had comparable postoperative outcomes with circulatory arrest times under and over 15 min. However, longer arrest times were associated with a higher risk of stroke.

Prophylactic intra-abdominal drainage during pancreaticoduodenectomy: A systematic review and meta-analysis

Background: Prophylactic abdominal drainage during pancreaticoduodenectomy (PD) is a common treatment strategy for pancreatic fistula. However, its benefits and safety have been the subject of debate. The objective of this meta-analysis and system review is to assess the effects of prophylactic drainage, various types of drainage (active and passive), and the timing of drainage removal (early and late) on the postoperative outcomes of PD. Methods: A systematic literature search was conducted in the PubMed, Web of Science, and Cochrane Library databases as of April 28, 2024. Randomized controlled trials (RCTs) comparing prophylactic abdominal drainage, different drainage patterns, and the timing of drainage removal after PD were included, and the postoperative outcomes were evaluated. Odds ratios (ORs) and 95% confidence intervals (95% CIs) were calculated to aggregate dichotomous outcomes. Meta-analysis was performed using the Mantel-Haenszel fixed- and random-effects models. Results: Nine RCTs, including a total of 1638 patients, were incorporated in our study. The meta-analysis showed no statistically significant differences in postoperative outcomes between the closed-suction drain (CSD) group and the passive drain to gravity (PDG) group. Compared to the late drain removal (LDR) group, the early drain removal (EDR) group had a significant reduction in the incidence of Clinically relevant postoperative pancreatic fistula (CR-POPF) (OR=0.39, 95% CI=0.20 to 0.79; P=0.009), morbidity (OR=0.41, 95% CI=0.20 to 0.84; P=0.01) and intra-abdominal infection (OR=0.40, 95% CI=0.22 to 0.75; P=0.004). For the group of present of drainage and the group of absent of drainage, the patient inclusion criteria of the included studies were too heterogeneous, making meta-analysis inappropriate. Conclusion: The existing evidence is insufficient to negate the necessity of prophylactic drainage after PD. The meta-analysis did not show superiority of any specific approaches of drainage tube. But this review did indicate that patients benefit from EDR in terms of CR-POPF, morbidity and intra-abdominal infection. EDR was recommended for low/intermediate risk patients.

The Suprascapular Artery as a Reference for the Evaluation of Supraspinatus Fatty Infiltration on Magnetic Resonance Imaging.

Fatty infiltration (FI) of the supraspinatus is commonly seen in chronic large-to-massive rotator cuff tears. Evaluating FI in patients with severe muscle atrophy can be confusing. The purpose of this study was to investigate the anatomic relationship between the suprascapular artery and supraspinatus muscle on magnetic resonance imaging (MRI) to provide a method for defining the border of the supraspinatus muscle on Y-view MRI. It was hypothesized that the branches of the suprascapular artery would encircle the supraspinatus muscle on Y-view and adjacent MRI slices and could be used for defining the supraspinatus outline on oblique sagittal images. Cohort study (diagnosis); Level of evidence, 3. A total of 172 shoulders that had undergone arthroscopic repair for large-to-massive rotator cuff tears were retrospectively included. Two methods, one based on the supraspinous fossa and trapezius (SF method) and the other based on the region bounded by the branches of the suprascapular artery (SA method), were used for defining the supraspinatus outline on Y-view MRI for the assessment of FI. Preoperative supraspinatus FI grade and tangent sign and postoperative tendon integrity were evaluated. Shoulder function was assessed using the American Shoulder and Elbow Surgeons (ASES) score and active range of motion. The branches of the suprascapular artery encircled the supraspinatus in all shoulders, with the diameter of the branches ranging from 0.5 to 3 mm. The agreement in supraspinatus FI grading between the SF and SA methods was 65.12%. When limited to the 61 shoulders with a positive tangent sign, the agreement dropped to 22.95% (κ = 0.032). The group (FI grade 2 by SA method and ≥3 by SF method) showed no significant difference in postoperative outcomes compared with the 2-vs-2 group but had significantly better postoperative ASES scores (P = .001) and active range of motion in forward elevation (P = .020) compared with the ≥3-vs-≥3 group. The tangent sign was positive in 92.16% of the 2-vs-≥3 group. The suprascapular artery is a reliable reference for the evaluation of supraspinatus FI. When a positive tangent sign presents, supraspinatus FI is likely to be overestimated if the hyperintensity outside the region bounded by the branches of the suprascapular artery is mistaken as FI.

Quantifying hubness to predict surgical outcomes in epilepsy: Assessing resection-hub alignment in interictal intracranial EEG networks.

Intracranial EEG can identify epilepsy-related networks in patients with focal epilepsy; however, the association between network organization and post-surgical seizure outcomes remains unclear. Hubness serves as a critical metric to assess network organization by identifying brain regions that are highly influential to other regions. In this study, we tested the hypothesis that favorable post-operative seizure outcomes are associated with the surgical removal of interictal network hubs, measured by the novel metric "Resection-Hub Alignment Degree (RHAD)." We analyzed Phase II interictal intracranial EEG from 69 patients with epilepsy who were seizure-free (n = 45) and non-seizure-free (n = 24) 1 year post-operatively. Connectivity matrices were constructed from intracranial EEG recordings using imaginary coherence in various frequency bands, and centrality metrics were applied to identify network hubs. The RHAD metric quantified the congruence between hubs and resected/ablated areas. We used a logistic regression model, incorporating other clinical factors, and evaluated the association of this alignment regarding post-surgical seizure outcomes. There was a significant difference in RHAD in fast gamma (80-200 Hz) interictal network between patients with favorable and unfavorable surgical outcomes (p = .025). This finding remained similar across network definitions (i.e., channel-based or region-based network) and centrality measurements (Eigenvector, Closeness, and PageRank). The alignment between surgically removed areas and other commonly used clinical quantitative measures (seizure-onset zone, irritative zone, high-frequency oscillations zone) did not reveal significant differences in post-operative outcomes. This finding suggests that the hubness measurement may offer better predictive performance and finer-grained network analysis. In addition, the RHAD metric showed explanatory validity both alone (area under the curve [AUC] = .66) and in combination with surgical therapy type (resection vs ablation, AUC = .71). Our findings underscore the role of network hub surgical removal, measured through the RHAD metric of interictal intracranial EEG high gamma networks, in enhancing our understanding of seizure outcomes in epilepsy surgery.

Low Rates of 30-Day Postoperative Complications After Meniscal Allograft Transplantation: A Retrospective Study Using the National Surgical Quality Improvement Program Database

PurposeThe purpose of this study is to determine the short-term (30-day) postoperative complication rates in patients undergoing meniscus allograft transplantation (MAT). MethodsAmerican College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database was queried for patients who had undergone MAT from 2014 to 2021 using Current Procedural Terminology (CPT) codes. Patients were excluded if they did not have sufficient demographic data – namely those without data for age, sex, BMI, preoperative functional status, ASA classification, operative time, and length of hospital stay. Post-operative complications within 30 days were identified and rates of complications were examined as the primary outcome of this study. As a secondary outcome, multivariate logistic regression was used to identify risk factors associated with the thirty-day incidence of post-operative complications. Subgroup analysis was performed to analyze differences in postoperative outcomes following isolated MAT versus MAT with concomitant ligament reconstruction/repair, cartilage preservation, or realignment osteotomy. ResultsA total of 396 meniscal transplants were identified, with mean age of 35.2 ± 14.9, mean body mass index (BMI) of 29.6 ± 6.7, mean length of stay of 0.5 ± 1.8 days. 11 patients experienced any adverse event (AAE), Specific complications included surgical site infections (5), deep vein thrombosis (DVT) (1), urinary tract infection (UTI) (3), and return to the operating room (OR) (2). On subgroup analysis, there was no significant difference between AAE rates in patients undergoing MAT with concomitant procedures compared to patients undergoing isolated MAT (7 vs 4, p=0.5). ConclusionPatients who underwent MAT had an overall complication rate of 2.8% in the short-term postoperative period (≤30 days). Patients undergoing MAT with concomitant ligament reconstruction/repair, cartilage preservation, and realignment osteotomy had similar rates of all postoperative complications when compared to patients undergoing isolated MAT. Level of EvidenceLevel IV, therapeutic case series.

Superior Capsule Reconstruction for Irreparable Rotator Cuff Tears Yields Good Clinical Outcomes for Patients With and Without Diabetes Mellitus

PurposeTo compare the clinical outcomes after superior capsule reconstruction (SCR) for irreparable rotator cuff tears (RCTs) in patients with and without diabetes mellitus (DM). MethodPatients who underwent SCR using fascia lata autograft for irreparable RCTs between 2012 and 2020 with a minimum 2-year follow-up were divided into non-DM and DM groups. Propensity score matching was used to select controls matched for patients’ characteristics. Only patients with HbA1c <8% were eligible. The Visual Analog Scale (VAS) for shoulder pain, American Shoulder and Elbow Surgeons (ASES) and Japanese Orthopaedic Association scores, and acromiohumeral distance were evaluated preoperatively and at 2 years postoperatively. Shoulder active range of motion (ROM) was evaluated preoperatively, at 6 months, 1 year, and 2 years postoperatively. Graft integrity and postoperative complications required additional surgery were evaluated. The Wilcoxon signed-rank test and Mann-Whitney U test were used to compare continuous variables. Pearson’s chi-squared test and Fisher’s exact test were used for categorical variables. The interaction between the postoperative period and ROM were analyzed by Friedman test and Wilcoxon rank sum test with Holm-Sidak post-hoc test. ResultsWe studied 154 patients (non-DM, 130; DM, 24) who underwent SCR. After matching, 21 patients were selected in each group. All clinical outcomes significantly improved at 2 years (all P<0.05) in both groups. We found no significant differences in clinical outcomes and rates of patients who achieved minimal clinically important differences of VAS and ASES scores between the groups (P=0.10-1.0). The rates of graft tear (both 9.5%) and complications (non-DM, 4.8%; DM, 0%) were not significantly different (both P=1.0). ConclusionSCR using fascia lata autograft for irreparable RCTs yields good clinical outcomes, including ROM, in patients with and without DM. No significant differences in postoperative outcomes were observed between the two groups. Level of EvidenceRetrospective cohort study, Level III.

Safety and efficacy of hepaticoduodenostomy for biliary reconstruction after extrahepatic mid-bile duct cancer surgery.

Bile duct resection and reconstruction for bile duct cancer (BDC) is a complex surgical and oncologic procedure that requires extensive resection and reconstruction of the biliary tract. Hepaticojejunostomy is commonly performed for biliary reconstruction after extrahepatic mid-bile duct resection, while hepaticoduodenostomy (HD) is performed only rarely due to the risk of ascending cholangitis. However, the efficacy of HD has not been well-established in extrahepatic mid-BDC surgery. In this study, we aimed to analyze the outcomes of HD in patients who underwent bile duct resection for extrahepatic mid-BDC. We retrospectively analyzed 38 extrahepatic mid-BDC patients who underwent bile duct resection in our center between January 2018 and June 2023. We compared postoperative outcomes, cancer recurrence, and patient survival between hepaticojejunostomy (n=20) and HD (n=18) groups. Operation time for the HD group was significantly shorter than that of the hepaticojejunostomy group (188 vs. 206 min, P=0.044) with no significant differences in postoperative outcomes. Regression analysis showed that a HD was not associated with a significantly high risk of cancer recurrence or decrease in patient survival. HD appears to have comparable operative benefits, postoperative complications, and oncologic outcomes to hepaticojejunostomy in extrahepatic mid-BDC patients.

Comparisons of laparoscopic and robotic pancreaticoduodenectomy using barbed and conventional sutures for pancreaticojejunostomy: a propensity score matching study.

There are limited data on the effect of different sutures and surgical approaches on the quality of pancreaticojejunostomy in minimally invasive pancreaticoduodenectomy (MIPD). This study compares the incidence of clinically relevant postoperative pancreatic fistula (CR-POPF) between the use of barbed sutures (BSs) and conventional sutures (CSs). A retrospective cohort study was conducted on 253 consecutive patients who had undergone MIPD from July 2016 to April 2023. Patients were excluded if conversion to open surgery or open anastomosis was necessary. 220 patients were enrolled and divided into BS (n = 148) and CS (n = 72) groups. After 1:1 propensity score matching (PSM), 67 cases remained in each group. Univariate and multivariate analyses identified factors associated with CR-POPF. Comparisons were also made between laparoscopic (LPD) and robotic (RPD) pancreaticoduodenectomy. After PSM, BSs were associated with significantly lower rates of CR-POPF (7.5 vs. 22.4%, P = 0.015) and severe complications (Clavien-Dindo ≥ III) (7.5vs. 19.4%, P = 0.043). No significant differences were found in operative time, length of postoperative hospital stay, or other major morbidities. Multivariate analyses revealed BMI 22kg/m2 (OR = 5.048, 95% CI: 1.256-20.287, P = 0.023) and the use of BSs (OR = 0.196, 95% CI: 0.059-0.653, P = 0.008) as the independent predictors of CR-POPF. There were no significant differences in postoperative outcomes between the LPD and RPD groups, but RPD was associated with significantly shorter operative time (402.8min vs. 429.4min, P = 0.015). In conclusion, using BSs for PJ during MIPD is feasible and has the potential to reduce CR-POPF and severe complications.

Mental Health Disorders and Surgical Outcomes in Patients With Bone and Soft Tissue Sarcoma.

We conducted a study to investigate the relationship between a mental health diagnosis (MHD) and postoperative outcomes in orthopedic patients with bone and soft tissue sarcoma. We hypothesized that patients with sarcoma with a preoperative MHD would have worse outcomes and more postoperative complications. A retrospective review was performed of 356 patients who underwent surgical treatment for bone or soft tissue sarcoma. Patients were divided into two groups: those with a diagnosis of depression, anxiety, bipolar disorder, and/or schizophrenia and those with no previous MHD. Statistical analysis was performed using independent t, Mann-Whitney U, and chi-square tests. Statistical analysis demonstrated significant differences between the MHD group and the control group in three outcomes: length of stay, 90-day readmission rate, and incidence of surgical site infections. Subgroup analysis of the MHD group yielded significantly higher 90-day readmission rates for patients who were diagnosed during sarcoma treatment. Patients with sarcoma and an MHD had a longer postoperative hospital stay, an increased 90-day readmission rate, and a greater risk of surgical site infection. Given the rising prevalence of mental health disorders nationwide, orthopedic surgeons should be aware of differences in postoperative outcomes between patients with sarcoma with and without mental illness. [Orthopedics. 20XX;4X(X):XXX-XXX.].

The impact of exvivo lung perfusion location on lung transplant outcomes.

Ex vivo lung perfusion (EVLP) conducted outside of the transplant center has increased in recent years to mitigate its limitation by resources and expertise. We sought to evaluate EVLP performed at transplant centers and externally. Lung transplant recipients were identified from the United Network for Organ Sharing Database. Recipients were then stratified into two groups based where they were perfused: Transplant Program (TP) or External Perfusion Centers (EPC). The groups were assessed with comparative statistics and long-term survival was assessed by Kaplan-Meier method. The groups were then 1:1 propensity and this process was repeated. EPC use was generally restricted to the Southern United States. Following matching, there were no significant differences in post-operative outcomes to include post-operative stroke, dialysis, airway dehiscence, ECMO use, ventilator use or incidence of primary graft dysfunction Grade 3. Adjusted 3-year survival was 68.9% (95% Confidence Interval [CI]: 60.9%-77.9%) for the TP group and 67.6% (95% CI: 61.0%-74.9%) for the EPC group (p = 0.69). In allografts with extended ischemia (14+ h), those in the TP group had significantly longer length of stay, prolonged ventilation and treated rejection in the 1st year, though no significant difference in mid-term survival (p = 0.66). EVLP performed at an EPC can be carried out with results and survival similar to allografts undergoing EVLP at a TP. EPCs will extend the valuable resource of EVLP to lung transplant programs without the resources to perform EVLP.

Outcomes of Deep Hypothermic Circulatory Arrest for Descending and Thoracoabdominal Aneurysm Repair

ObjectiveDeep hypothermic circulatory arrest (DHCA) in patients undergoing descending (DTAA) or thoracoabdominal aortic aneurysm (TAAA) repair is associated with increased morbidity and mortality. We present our outcomes after open DTAA and TAAA repair with and without DHCA. MethodsFrom 1999 to 2022, 81 (38.8%) patients undergoing DTAA or TAAA repair required DHCA because proximal cross-clamping was not feasible or aneurysmal pathology extended into the arch and 128 (61.2%) patients required only distal bypass. Because of intrinsic pathological differences in patients requiring DHCA, confidence intervals were used to compare groups in lieu of formal hypothesis tests. ResultsDHCA patients had more chronic dissections (64.2% vs 43.8%, 95% CI for difference: 6% - 35%) and higher BMIs (29.5 ± 6.8 vs 27.2 ± 6.6, CI: 26% - 421%). More non-DHCA patients had medial degeneration (9.9% vs 31.3%, CI: -33% - -7%). There were 10 (12.4%) in-hospital deaths for the DHCA and 10 (7.8%) for the non-DHCA group (CI: -5% - 14%). Survival at 10 years was 52.6% (CI: 42.1%-65.7%) for the non-DHCA group and 48.3% (CI: 40.3%-57.9%) for the DHCA group. The only meaningful differences in postoperative outcomes were ICU (5.5 days vs 6 days, CI: 12%-410%) and hospital stay (19 days vs 12 days, CI: 74%-470%), which were longer in the DHCA group. ConclusionsDespite longer ICU and hospital length of stays, selective use of DHCA is safe and effective with comparable morbidity and mortality to non-DHCA in open DTAA and TAAA repair.

Association of Hospital System Affiliation with Spending and Postoperative Outcomes: A Longitudinal Study of Hospital Mergers And Acquisitions From 2010 To 2018.

To determine whether hospital system affiliation was associated with changes in surgical episode spending or postoperative outcomes. Over 70% of US hospitals are now part of a hospital system. The presumed benefits of hospital consolidation include concentrating volume and expertise, care integration, and investment in quality improvement. However, there is conflicting evidence as to whether expanding hospital systems are actually reducing health spending or improving quality. These observations call into question whether systems are leveraging their collective volume and experience to standardize care and maximize efficiencies. The American Hospital Association Annual Survey was used to identify whether a hospital was part of a system and in which year a hospital joined the respective system. Using 100% Medicare claims data, we identified fee-for-service Medicare patients undergoing elective inpatient coronary artery bypass graft colon resection, lung resection, hip replacement, or knee replacement from 2010 to 2018. We used a difference-in-differences framework to evaluate hospital spending and outcomes before and after joining a system. The primary outcome was Medicare 30-day episode spending, with specific attention to the total episode payment, index hospitalization, and post-acute care components. Secondary outcomes included serious complications, 30-day mortality, and 30-day readmission. The cohort included 3,395,565 Medicare beneficiaries who underwent surgery between 2010 and 2018. Patients were treated at 3961 hospitals, of which 1097 (27.7%) were never in a system, 2262 (57.1%) were always in a system, and 602 (15.2%) joined a system during the study period. By 1 year after system affiliation, 30-day episode spending had decreased by $303 (95% CI: 63, 454, P=0.01), and after 5 years, 30-day episode spending decreased by $429 (95% CI: 5, 853, P=0.04). One year after system association, index hospitalization spending was not statistically different from before system affiliation ($-30, 95% CI: -160, 100, P=0.65). Conversely, 1 year after system association, postacute care spending decreased by $268 (95% CI: 107, 429, P<0.01) and remained lower for ≥5 years. There was no significant change in hospitals serious complications (-0.14, 95% CI: -0.40, 0.11, P=0.27), 30-day readmission (-0.14, 95% CI:-0.52, 0.25, P=0.48), or 30-day mortality (-0.08, 95% CI: -0.18, 0.03, P=0.17), 1 year after joining a system; similar patterns were observed at three and ≥5 years. system affiliation was associated with a small decrease in 30-day episode spending, driven by decreased spending in postacute care services. Notably, there was no difference in postoperative outcomes after system affiliation.

Retrospective study on the feasibility and safety of laparoscopic surgery for complicated fistulizing diverticular disease in a high-volume colorectal center.

We assessed feasibility and safety of laparoscopic sigmoidectomy for complicated fistulizing diverticular disease in a tertiary care colorectal center. A single-center retrospective study of patients undergoing sigmoidectomy for fistulizing diverticular disease between 2011 and 2021 was realized. Primary outcomes were rates of conversion to open surgery and severe postoperative morbidity at 30 days. Secondary outcomes included rates of postoperative bladder leaks on cystogram. Among the 104 patients, 32.7% had previous laparotomy. Laparoscopy was the initial approach in 103 (99.0%), with 6 (5.8%) conversions to laparotomy. Clavien-Dindo grade ≥ III complication rate at 30 days was 10.6%, including two (1.9%) anastomotic leaks. The median postoperative length of stay was 4.0 days. Seven (6.7%) patients underwent reoperation, six (5.8%) were readmitted, and one (0.9%) died within 30 days. Twelve (11.5%) ileostomies were created initially, and two (1.9%) were created following anastomotic leaks. At last follow-up, 101 (97.1%) patients were stoma-free. Urgent surgeries had a higher rate of severe postoperative complications. Among colovesical fistula patients (n = 73), postoperative cystograms were performed in 56.2%, identifying two out of the three bladder leaks detected on closed suction drains. No differences in postoperative outcomes occurred between groups with and without postoperative cystograms, including Foley catheter removal within seven days (73.2% vs. 90.6%, p = 0.08). Laparoscopic surgery for complicated fistulizing diverticulitis showed low rates of severe complications, conversions to open surgery and permanent stomas in high-volume colorectal center.

Poster 296: Comparing Outcomes of Osteochondral Allograft Transplantation of the Knee Preserved by the Missouri Osteochondral Preservation System to Standard Preservation Methods

Objectives: Osteochondral allograft (OCA) transplantation is an established surgical intervention for full-thickness chondral defects. Standard Preservation (SP) protocols currently allow for osteochondral allografts to be stored for a maximum of 28 days after procurement. The Missouri Osteochondral Allograft Preservation System allows for grafts to be stored for at least 60 days after procurement. The purpose of this study is to compare clinical and radiographic outcomes in patients that have undergone OCA transplantation utilizing Missouri Osteochondral Allograft Preservation System (MOPS) to standard preservation protocols. Methods: Retrospective review identified all patients who underwent OCA transplantation between 2012 and 2018. Patients without appropriate follow-up, postoperative outcomes, or necessary imaging were excluded. All patients had at least 2-year follow-up data. Patient demographics, outcomes, and graft information were compared between patients who received grafts preserved by MOPS and standard preservation as previously defined. Results: Sixty-four patients were included. Twenty-five were in the MOPS group and 39 in the SP group. Members of the MOPS group were younger at the time of surgery than those in the SP group (28.6 ± 10.7 years in MOPS vs. 36.7 ± 10.9 in SP group, P = 0.005). Seventy-six grafts were analyzed with 39 grafts in the MOPS group and 37 in the SP group. Grafts in the MOPS group were stored longer (average 50.03 days) than grafts in the SP group (average 23.18 days) (P &lt; 0.001). No difference between groups was found in complications or reoperation rates. Outcomes between the 2 groups showed no statistical differences for complications or revisions as well as similar Knee Injury and Osteoarthritis Outcome Scores for Joint Replacement, International Knee Documentation Committee scores, 12-item psychosocial safety climate scores, and 12-item mental health component summary scores. Conclusions: Grafts preserved using the MOPS were stored for more than double the length of time than grafts preserved with standard preservation techniques. There was no difference in postoperative outcomes following OCA transplantation regardless of preservation method used.

Comparative analysis of surgical techniques in the management of chronic subdural hematomas and risk factors for poor outcomes.

Chronic subdural hematomas (CSDH) are increasingly prevalent, especially among the elderly. Surgical intervention is essential in most cases. However, the choice of surgical technique, either craniotomy or burr-hole opening, remains a subject of debate. Additionally, the risk factors for poor long-term outcomes following surgical treatment remain poorly described. This article presents a 10-year retrospective cohort study conducted at a single center that aimed to compare the outcomes of two common surgical techniques for CSDH evacuation: burr hole opening and minicraniotomy. The study also identified risk factors associated with poor long-term outcome, which was defined as an mRS score ≥ 3 at 6 months. This study included 582 adult patients who were surgically treated for unilateral CSDH. Burr-hole opening was performed in 43% of the patients, while minicraniotomy was performed in 57%. Recurrence was observed in 10% of the cases and postoperative complications in 13%. The rates of recurrence, postoperative complications, death and poor long-term outcome did not differ significantly between the two surgical approaches. Multivariate analysis identified postoperative general complications, recurrence, and preoperative mRS score ≥ 3 as independent risk factors for poor outcomes at 6 months. Recurrence contribute to a poorer prognosis in CSDH. Nevertheless, use burr hole or minicraniotomy for the management of CSDH showed a similar recurrence rate and no significant differences in post-operative outcomes. This underlines the need for a thorough assessment of patients with CSHD and the importance of avoiding their occurrence, by promoting early mobilization of patients. Future research is necessary to mitigate the risk of recurrence, regardless of the surgical technique employed.

Association Between Preoperative Patient Resilience and Patient-Reported Outcomes After Rotator Cuff Repair.

Mental and emotional health can affect outcomes after orthopaedic surgery, and patient resilience has been found to be significantly related to postoperative functional outcomes. To evaluate the relationship between preoperative patient resilience and 2-year postoperative patient-reported outcomes after rotator cuff repair (RCR). It was hypothesized that patients with low preoperative resilience will have worse patient-reported outcomes at 2 years after RCR versus those with high resilience. Cohort study; Level of evidence, 3. Patients who underwent primary arthroscopic RCR in 2020 at a single institution and completed the Brief Resilience Scale (BRS) preoperatively were identified. Other inclusion criteria were American Shoulder and Elbow Surgeons (ASES) and Single Assessment Numeric Evaluation (SANE) scores at the 2-year follow-up. Outcomes were compared in patients as divided into low resilience (BRS score >1 SD below the mean), normal resilience (BRS score ≤1 SD of the mean), and high resilience (BRS score >1 SD above the mean) groups. Overall, 100 patients (52 male, 48 female; mean age, 60 ± 9 years) were included in this study. Mean BRS scores did not change significantly from preoperative to 2-year follow-up (3.8 ± 0.7 vs 3.9 ± 0.8, P = .404). All patients had preoperative ASES scores. Low-resilience patients (n = 17) had significantly lower preoperative ASES scores compared with normal (n = 64) and high resilience (n = 19) patients (35 vs 42 vs 54, respectively; P = .022). There were no significant group differences in postoperative outcomes (revision rate, ASES score, ASES score improvement from preoperative to 2-year follow-up, or SANE score). Multivariate analysis indicated that preoperative resilience was not significantly associated with ASES score improvement (β estimate = -5.64, P = .150), while resilience at 2-year follow-up was significantly related to ASES score improvement (β estimate = 6.41, P = .031). Patient-reported outcomes at 2-year follow-up did not differ based on preoperative patient resilience for arthroscopic RCR patients. Multivariate analysis also showed that preoperative resilience was not associated with improvement in ASES scores; however, resilience at 2-year follow-up was associated with ASES score improvement.